FAQs on Occlusion & TMJs

What is occlusion?

Occlusion is the way teeth come together. Normal occlusion is constricted , asymptomatic and provides stable tooth contacts upon closing of jaws.

Signs of pathological occlusion are:

  • Instability of tooth contacts i.e. partial or fully non-dentate patients
  • Tooth mobility
  • Bruxism – tooth grinding or clenching
  • Tooth pain
  • Tooth wear
What is a Temporo-Mandibular Joint – TMJ?

The TMJs are natural anatomical head-jaw joints and are located right in front of the ears. Each TMJ is composed of

  • the ball-shaped condyle of the mandible(lower jaw)
  • the fossa of the cranium
  • the discus, namely the anatomical connective tissue drape that intervenes between the fossa and the condyle
  • the ligaments and discal tissues of the kondyle-fossa complex

The TMJs play a mostly significant role in the movement of the jaw during speech and mastication.

They are driven by muscles of the face, neck and of the temples.

Upon jaw movements the TMJs must be in harmony and free of pain and discomfort.

In major prosthetic reconstructions the TMJs may shift their posture in the fossa, thus triggering symptoms such as discomfort, pain and restricted jaw movement. Hence, one of our main concerns is to maintain health and function of the TMJs. Most noteworthly, aesthetic navigation of prosthetic reconstructions must be controlled by occlusal contacts and the TMJs.

At Dental Aesthetics Athens we are very keen on reconstructing dentitions in the most orthopedically stable position of the TMJs, which by definition is tension-free and fully relaxed.

How does occlusion relate to facial-, tooth- or ear pain?

Orofacial pain is referred on face, head ,ear, jaws and teeth. Some occlusal entities may produce pain that can be very confusing. Mal-occlusion is mainly produced by interferences between teeth and can restrict the movement of the mandible (lower jaw) . Muscles, that drive the jaw, can therefore be over- contracted or elongated, thus producing spasm and severe pain.

Why is occlusion one of our main concerns?

Upon restoring large segments of dentition, special concerns arise as to how to 3-D-position the prosthetic reconstructions. Initially, 3-D planning of new dentition is designed according to aesthetic analysis (see:aesthetic analysis and DSD). As navigated by aesthetic analysis, trial restorations (see: temporary restorations) are faithfully re-producing the aesthetic prototype, however new occlusion is given. New scheme of occlusion confirms the intended aesthetics, whereas new dentition must be built in the one and only tension-free position of the mandible (centric relation).

Most frequent symptoms related to TMJs’ and Occlusal issues

Jaw/pre-auricular/ear/temple pain upon chewing
Unstable contacts between upper and lower teeth – patient cannot find one constricted position of their teeth (pathway of occlusion)
Tooth wear
Tooth mobility being not related to periodontitis
Jaw/pre-auricular/ear/temple pain upon closing or opening of the lower jaw
Sounds at TMJs being produced upon closure or opening of the jaw
Pain on one of two eyes upon movement of jaw – muscle pain referring to eye
Muscle pain upon palpation
Difficulty on closing/opening of jaw (muscle splinting)

Common treatment modalities addressing occlusal issues

Special custom-made removable appliances (mouth guards), that lock onto the upper or lower dentition and re-direct the lower jaw in a tension-free position. Relief from symptoms can hence be immediate
Conservative selective adjustment of teeth contacts, that interfere in occlusion and produce tension and pain on the face, neck or face (muscular spasm)
Orthodontic treatment addressing occlusal dysfunctions such as open bite, deep overbite, protruded teeth can predictably result in easy and fast relief
Application of prep-less bonded composite prosthetic restorations on natural teeth . Thus increasing the vertical dimension of occlusion (VDO) ,optimizing the Occlusal contacts and unlocking the teeth from deep overbite
Fixed prosthodontics provide stable occlusal contacts of the teeth and adequately support the joints